Contributions
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 11:45 to 12.06.2015 12:00
Location: Room Lehar 1 + 2
Background
We compared long-term outcomes of allogeneic transplantation (alloHCT) vs. autologous (auto) HCT in pts with G-I/II follicular lymphoma (FL) in the rituximab-era.
Aims
To compared survival outcomes following autoHCT vs. alloHCT in G-I/II FL, when either modality is used as the first transplantation approach.
Methods
Adult pts with relapsed/refractory G-I/II FL undergoing 1st RIC alloHCT or 1st autoHCT reported to Center for International Blood and Marrow Transplant Research during 2000-12 were eligible. Pts with large cell transformation and those not receiving rituximab before HCT were excluded.
Results
Characteristics of 518 pts included in this analysis are shown in Table 1. AlloHCT pts were younger, more heavily pretreated, had more advanced stage disease, had longer interval between diagnosis and HCT, more extranodal involvement and were chemotherapy resistant compared with auto-HCT pts. The 5-year adjusted probabilities of non-relapse mortality (NRM), relapse/progression, progression-free survival (PFS) and overall survival (OS) of autoHCT vs. alloHCT groups were 5% vs. 26% (p<0.0001); 54% vs. 20% (p<0.0001); 41% vs. 58% (p<0.001) and 74% vs. 66% (p=0.05), respectively. Cumulative incidence of second malignancies at 5 years did not differ significantly (alloHCT=8%; autoHCT=5%). On multivariate analysis (MVA) autoHCT was associated with reduced NRM (RR=0.21; p<0.0001) and time varying effects were seen on other outcomes. Within the first 5 and 11months post HCT, auto- and alloHCT had similar relapse/progression and PFS. AutoHCT was associated with a higher risk of relapse/progression beyond 5 months post HCT (RR=4.4; p<0.0001), and worse PFS (RR=2.9; p<0.0001) beyond 11 months post HCT, respectively. In the first 24 months post HCT, autoHCT was associated with improved OS (RR=0.41; p<0.0001), but beyond 24months with inferior OS (RR=2.2; p=0.006). A landmark analysis of pts alive and progression-free at 2-years post HCT confirmed these observations, showing no difference in NRM between the auto- and alloHCT groups, but significantly higher risk of relapse/progression (RR=7.3; p<0.0001) and inferior PFS (RR=3.2; p<0.0001) and OS (RR=2.1; p=0.04) following autoHCT.
Table 1 | AlloHCT N=268 | AutoHCT N=205 | P |
Median age, years | 52 (27-74) | 54 (22-79) | 0.01 |
KPS ≥90 | 193 (72) | 168 (67) | 0.06 |
Stage III-IV at diagnosis | 217 (81) | 185 (74) | <0.0001 |
Extranodal disease at HCT | 10 (26) | 40 (16) | 0.002 |
Prior rituximab-resistance | 118 (44) | 161 (64) | <0.001 |
Chemosensitive at HCT | 202 (75) | 226 (90) | <0.001 |
Median lines of therapy | 4 (1-5) | 3 (1-5) | 0.001 |
Duration of 1st response |
|
| 0.76 |
<1 year | 79 (29) | 68 (27) |
|
≥1 year | 173 (65) | 164 (66) |
|
Time from diagnosis to HCT | 43mon (4-352) | 34mon (6-315) | 0.001 |
Matched sibling Donor | 143 (53) | N/A |
|
≥7/8 unrelated donor | 125 (46) | N/A | - |
Median follow up | 61 (3-154) | 61 (3-169) | - |
Summary
RIC alloHCT as 1st transplant approach provides better long-term survival outcomes for G-I/II FL.
Session topic: Stem cell transplantation: Clinical 1
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 11:45 to 12.06.2015 12:00
Location: Room Lehar 1 + 2
Background
We compared long-term outcomes of allogeneic transplantation (alloHCT) vs. autologous (auto) HCT in pts with G-I/II follicular lymphoma (FL) in the rituximab-era.
Aims
To compared survival outcomes following autoHCT vs. alloHCT in G-I/II FL, when either modality is used as the first transplantation approach.
Methods
Adult pts with relapsed/refractory G-I/II FL undergoing 1st RIC alloHCT or 1st autoHCT reported to Center for International Blood and Marrow Transplant Research during 2000-12 were eligible. Pts with large cell transformation and those not receiving rituximab before HCT were excluded.
Results
Characteristics of 518 pts included in this analysis are shown in Table 1. AlloHCT pts were younger, more heavily pretreated, had more advanced stage disease, had longer interval between diagnosis and HCT, more extranodal involvement and were chemotherapy resistant compared with auto-HCT pts. The 5-year adjusted probabilities of non-relapse mortality (NRM), relapse/progression, progression-free survival (PFS) and overall survival (OS) of autoHCT vs. alloHCT groups were 5% vs. 26% (p<0.0001); 54% vs. 20% (p<0.0001); 41% vs. 58% (p<0.001) and 74% vs. 66% (p=0.05), respectively. Cumulative incidence of second malignancies at 5 years did not differ significantly (alloHCT=8%; autoHCT=5%). On multivariate analysis (MVA) autoHCT was associated with reduced NRM (RR=0.21; p<0.0001) and time varying effects were seen on other outcomes. Within the first 5 and 11months post HCT, auto- and alloHCT had similar relapse/progression and PFS. AutoHCT was associated with a higher risk of relapse/progression beyond 5 months post HCT (RR=4.4; p<0.0001), and worse PFS (RR=2.9; p<0.0001) beyond 11 months post HCT, respectively. In the first 24 months post HCT, autoHCT was associated with improved OS (RR=0.41; p<0.0001), but beyond 24months with inferior OS (RR=2.2; p=0.006). A landmark analysis of pts alive and progression-free at 2-years post HCT confirmed these observations, showing no difference in NRM between the auto- and alloHCT groups, but significantly higher risk of relapse/progression (RR=7.3; p<0.0001) and inferior PFS (RR=3.2; p<0.0001) and OS (RR=2.1; p=0.04) following autoHCT.
Table 1 | AlloHCT N=268 | AutoHCT N=205 | P |
Median age, years | 52 (27-74) | 54 (22-79) | 0.01 |
KPS ≥90 | 193 (72) | 168 (67) | 0.06 |
Stage III-IV at diagnosis | 217 (81) | 185 (74) | <0.0001 |
Extranodal disease at HCT | 10 (26) | 40 (16) | 0.002 |
Prior rituximab-resistance | 118 (44) | 161 (64) | <0.001 |
Chemosensitive at HCT | 202 (75) | 226 (90) | <0.001 |
Median lines of therapy | 4 (1-5) | 3 (1-5) | 0.001 |
Duration of 1st response |
|
| 0.76 |
<1 year | 79 (29) | 68 (27) |
|
≥1 year | 173 (65) | 164 (66) |
|
Time from diagnosis to HCT | 43mon (4-352) | 34mon (6-315) | 0.001 |
Matched sibling Donor | 143 (53) | N/A |
|
≥7/8 unrelated donor | 125 (46) | N/A | - |
Median follow up | 61 (3-154) | 61 (3-169) | - |
Summary
RIC alloHCT as 1st transplant approach provides better long-term survival outcomes for G-I/II FL.
Session topic: Stem cell transplantation: Clinical 1